| NPI | 1093374415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 12607-MH-CC) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA LPCC18467) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2025-09-12 |